Import kidney offers and DonorNet: a view from the trenches

The ability of DonorNet2007(®) screening functions to expedite placement of locally rejected kidneys is unknown. We separately evaluated non-mandatory share regional (n = 641) and national (n = 720) kidney offers to our center between 5/2007 and 2/2009 for cold ischemia time at offer (oCIT) with respect to candidate ranking to identify donor factors associated with early oCIT and assess the impact of screening functions. oCIT was <7 h after recovery in 83.2% of regional and 34% of national offers. Of national offers, donor characteristics significantly (p < 0.05) associated with oCIT less than median (10 h) were as follows: age <4 yr (vs. 4-35 yr), age >69 yr (vs. 60-69 yr), serum creatinine peak >2.0 and terminal >2.0 mg/dL, and glomerulosclerosis >15% (vs. 0-5%). The trend in early offers was predominantly attributed to greater proportions of pre-recovery offers. Only one factor, age >69 yr, was significantly associated with proportionately more offers at low sequence numbers. Our data suggest an effect of age within DonorNet(®) screening functions to reduce candidate list size and result in earlier offers. Shorter offer oCITs are otherwise occur largely because of pre-recovery offers from donors with certain types of pre-recovery characteristics.